SUBJECT:
MEDICARE MODERNIZATION ACT OF 2003; MEDICARE PART D UPDATE
DISCUSSION:
Effective January 1, 2006, Medicaid recipients, that have Medicare, will have to be enrolled in a Medicare Part D plan to receive prescription drug coverage. Medicaid will no longer pay for prescription drugs for these individuals after January 1, 2006. Most Medicare recipients will have a premium for Part D, however, Medicaid recipients and some other Medicare recipients will be eligible for a low-income subsidy.
The Social Security Administration is referring to the low-income subsidy program as “extra help” in paying for prescription drugs. The amount of the low-income subsidy will depend on the individual Medicare beneficiary's income. Medicaid/Medicare dual eligible recipients will receive a full subsidy, which means they will not have a premium.
Beginning May 20, 2005, through June 30, 2005, individuals who are considered “deemed eligible” will be mailed a letter ( copies attached ) informing them that they are deemed eligible for Medicare Part D low income subsidy. A “deemed eligible” individual is an individual who receives both Medicare and Medicaid; receives QMB, SLMB or QI-1 (Missouri's SLMB-2) or receives SSI. These individuals do not have to apply for the “extra help”. Later in the year they will receive a notice that they must enroll in a drug plan.
NOTE: On June 6, 2005, states received notice that some of the Medicare beneficiaries received an empty envelope or received two letters in the same envelope. These letters do not contain any identifying information, only the name and address on the envelope. Inquiries about this mail should be instructed to call 1-800-MEDICARE (1-800-633-4227).
Beginning May 25, 2005, through August 31, 2005, low income Medicare beneficiaries, except those listed above, will be mailed an application ( copy attached 
) packet for the low-income subsidy. The packet includes an application form with a prepaid addressed envelope to be completed and returned to the Social Security Administration (SSA). The original application is a scannable document which must be used by the beneficiary. Verification of income and resources are not required. Photo copies of the application should not be submitted to SSA.
Beginning July 1, 2005, beneficiaries may apply for the “extra help” on-line by logging on to www.Medicare.gov .
Beginning November 15, 2005, beneficiaries may begin enrolling in a Medicare Part D prescription drug plan. Medicaid recipients who do not enroll in a plan by December 31, 2005, will be auto enrolled in a plan.
Since these mailings are being staggered, friends, neighbors and spouses may not receive the mailing at the same time.
If an individual calls to request an application for the low-income subsidy “extra help”, they should be directed to contact SSA and ask for “the application for help with Medicare Prescription Drug Plan Costs” at 1-800-MEDICARE (1-800-633-4227) or visit www.Medicare.gov .
Individuals who come to the local Family Support Division (FSD) office to inquire or apply for “extra help” are to be given an application unless they bring their own copy. Staff must assist the individual in completing the application and mailing the application in the prepaid envelope. An initial supply of the application and prepaid envelopes are being sent to each county office. Staff must also screen these individuals for Medicaid and the Medicare Savings Programs (QMB, SLMB and QI-1).
These mailings will likely result in additional inquiries to FSD staff. Individuals who contact a county office or their caseworker for more information should be instructed to call 1-800-MEDICARE (1-800-633-4227).
NECESSARY ACTION:
- Share this memorandum with all staff immediately.
- Assist individuals with inquiries concerning the Medicare Prescription Drug Plan.
- Screen individuals for other types of assistance.
Attachments:
CMS Pub. No. 11132
CMS Pub. No. 11133
Application